Item banks for measurement of refractive error-specific quality of life.

PURPOSE: To evaluate the psychometric properties of refractive error-specific quality of life (QoL) item banks and assess their performance using computerised adaptive testing (CAT) simulations. METHODS: In this cross-sectional study a 392-item questionnaire, grouped under 11 QoL domains, was interviewer-administered to 305 people with refractive error [mean age ± S.D., 30.5 ± 14.1 (range (18 to 83) years; male, 50.5%; mean ± S.D. spherical equivalent refractive error -2.4 ± 2.9 (range: -15.0 to +11.0) Dioptres; spectacles (n = 257), contact lens (n = 37), refractive surgery (n = 25), uncorrected refractive error (n = 57)]. Rasch analysis was conducted on each QoL domain using the Andrich rating scale model to investigate parameters including response category functioning, person- and item-reliability, infit and outfit statistics, unidimensionality, targeting, differential item functioning and local item dependency. The resulting item banks underwent CAT simulations in 1,000 cases with 'high' and 'moderate' precision stopping rules. RESULTS: Rasch analysis iterations resulted in 13 refractive error-specific item banks (Convenience, Health concerns, Economic, Activity limitation, Mobility, Emotional, Social, Visual symptoms frequency, Visual symptoms severity, Visual symptoms bothersome, Comfort symptoms frequency, Comfort symptoms severity and Comfort symptoms bothersome), containing a total of 366 items. The item banks had good psychometric properties including satisfactory measurement precision, infit and outfit statistics and unidimensionality. In CAT simulations, the mean number of items required to achieve high and moderate measurement precision was 9.4 and 4.7, respectively. CONCLUSION: Overall, refractive error-specific QoL item banks show promise in their ability to comprehensively and precisely evaluate a range of quality of life parameters. These items banks when administered using a CAT system offer unique outcome tools for implementation in clinical trials, healthcare and research.

Influence of the COVID-19 pandemic on contact lens wear in Spain.

PURPOSE: To investigate the behaviour of contact lens (CL) wearers in Spain during the COVID-19 pandemic. METHODS: An anonymized web-based questionnaire was used to assess demographics, CL history, and activity, CL wear habits and perceived risk of infection due to CL wear during the COVID-19 pandemic. RESULTS: A total of 737 participants with an average age of 27.4 (±9.3) years completed the online questionnaire. The vast majority of respondents were soft CL wearers and reported at least two years of CL wear. Patients concerns about the increased risk of SARS-CoV-2 infection due to CL wear (40.6 % of participants) were significantly related (χ2(1) = 11.195, p < 0.05) to CL discontinuation (46 % of participants) during the COVID-19 pandemic. This fact joins the significant changes in the frequency of CL wear during the COVID-19 pandemic (χ2(4) = 31.982, p < 0.05), with a tendency to increase occasional CL wear from 29.1 % to 61.8 %. Interestingly, the majority of respondent (87.9 %) indicated that no professional had offered them information related to CL wear and COVID-19, and that they had not sought it on their own (82.2 %). CONCLUSION: There is a relationship between the perceived risk of infection and CL dropout during the COVID-19 pandemic, and a tendency to change the CL frequency of wear, with an increase in occasional CL wear. During the ongoing pandemic, eye care practitioners should reinforce CL patient education to minimize the risk of SARS-CoV-2 infection and CL-related complications requiring clinical care.

Impact of Refractive Errors on Da Vinci SI Robotic System.

OBJECTIVE: To investigate the impact of refractive errors on binocular visual acuity while using the Da Vinci SI robotic system console. METHODS: Eighty volunteers were examined on the Da Vinci SI robotic system console by using a near vision chart. Refractive errors, anisometropia status, and Fly Stereo Acuity Test scores were recorded. Spherical equivalent (SE) were calculated for all volunteers' right and left eyes. Visual acuity was assessed by the logarithm of the minimal angle of resolution (LogMAR) method. Binocular uncorrected and best corrected (with proper contact lens or glasses) LogMAR values of the subjects were recorded. The difference between these values (DiffLogMAR) are affected by different refractive errors. RESULTS: In the myopia and/or astigmatism group, uncorrected SE was found to have significant impact on the DiffLogMAR (p < 0.001) and myopia greater than 1.75 diopter had significantly higher DiffLogMAR values (p < 0.05). Subjects with presbyopia had significantly higher DiffLogMAR values (p < 0.01), and we observed positive correlation between presbyopia and DiffLogMAR values (p = 0.33, p < 0.01). The cut off value of presbyopia that correlated the most with DiffLogMAR differences was found to be 1.25 diopter (p < 0.001). In 13 hypermetropic volunteers, we found significant correlation between hypermetropia value and DiffLogMAR (p > 0.7, p < 0.01). The statistical analysis between Fly test and SE revealed a significant impact of presbyopia and hypermetropia to the stereotactic view of the subject (p = -0.734, p < 0.05). CONCLUSION: Surgeons suffering from myopia greater than 1.75 diopter, presbyopia greater than 1.25 diopter (D), and hypermetropia regardless of grade must always perform robotic surgeries with the proper correction.

Investigation of the impact of blur under mobile attentional orientation using a vision simulator.

It is well-known that correction of blur can improve visual perception. However, it is unclear how the beneficial effect of correction is affected by the regions of correction and the spatial uncertainty introduced by the retinal stimulation. The purpose of this study was two-fold: first, to compare the impacts of blur correction between isoeccentric locations of the visual field; and second, to evaluate the effect of spatial cueing in each corrected location on performing a simple task. Five subjects were asked to complete a simple detection task of a small dark spot stimulus presented randomly at four cardinal retinal locations (eccentricity: 5°) under manipulation of attention via an exogenous cue. Both clear and blurred targets were randomly displayed across the visual field and viewed monocularly through a vision simulator, used to minimize peripheral ocular aberrations. Results confirmed the advantage of clear vs/ blurred images under spatial uncertainty. It was also found that the visual benefit from blur correction is unequal at isoeccentric locations, even for a simple detection task. While manipulation of attention in the presence of spatial uncertainty significantly modulated response time (RT) performance, no differential effect was observed for clear and blurred stimuli, suggesting that attention has only a small effect on the optical benefit for a simple detection task when the display is depleted (no distractor). Those observations highlight the importance of field performance asymmetries in optical interventions and may offer useful implications for the design of extrafoveal refractive correction. Further studies are needed to elucidate how the focus of attention interacts with the perceived gain of vision correction.

Disability-related-distress in primary school learners with vision impairment due to uncorrected refractive error in KwaZulu-Natal Province, South Africa - a qualitative study.

BACKGROUND: Uncorrected refractive error (URE) is a major cause of vision impairment among children that impacts negatively on their lives including distresses. We aim to understand the disability-related distress among vision-impaired children due to URE in rural and semi-rural South Africa using qualitative techniques. METHODS: Structured focus groups of children (aged 5-12 years old) with normal vision and vision impairment due to URE from four schools in Pinetown, KwaZulu Natal, South Africa, were performed (four mixed-gender group discussions and eight single gender group discussions). We recruited the study participants after the children underwent standardised vision screening. Criterion sampling was used when selecting study participants. The interviews were transcribed to identify meaning units and broken down to condensed meaning units, which were then grouped into megathemes. Themes were then generated. RESULTS: Thirteen children with normal vision and 63 children with vision impairment due to URE participated in the twelve focus group discussions with 36 boys (47%) and 40 girls (53%). Twelve themes were generated. The megathemes were Loss of Self Confidence (number of themes (n) = 3), Loss of self-worth (n = 3), Loss of interconnection/ interaction with community (n = 2), Humiliation (n = 2) and Discrimination (n = 2). CONCLUSIONS: We found that vision impairment due to URE can cause distress in different domains in children's life and further grouped them into different themes. The themes will be used for the development of a tool to assess disability-related distress among children with vision impairment due to URE. We also recommend that distresses caused by URE should be taken into consideration when designing eye care programmes for children.

Vision-Related Quality of Life and Perception of Military Readiness and Capabilities Following Refractive Surgery Among Active Duty U.S. Military Service Members.

PURPOSE: To assess vision-related quality of life and military readiness and capabilities among active duty U.S. military service members undergoing refractive surgery. METHODS: In this prospective, single-center, observational study, active duty U.S. military service members electing to undergo refractive surgery were asked to complete a military performance questionnaire and the National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42) preoperatively and at 6 months postoperatively. On the military performance questionnaire, participants rated (1 = very bad to 5 = very good) how they felt their vision affected their military readiness and capabilities after refractive surgery. RESULTS: Among 360 participants at 6 months postoperatively, the overall mean military performance score increased from 3.6 ± 0.8 to 4.8 ± 0.3, a change of 1.2, with 91.7% of the participants indicating an overall improvement in readiness and capability (P < .001). Scores measuring overall individual readiness, contribution to unit's mission, use of night vision goggles, function at night, weapons sighting ability, employment of personal masks, weather extreme environmental conditions, and optical support were significantly higher postoperatively (P < .001). For the NEI RQL-42, scores were significantly higher postoperatively for the subscales clarity of vision, expectations, near vision, far vision, diurnal fluctuations, activity limit, glare, dependence on correction, worry, appearance, and satisfaction with correction (all P < .001), but not for symptoms after refractive surgery (P = .403). CONCLUSIONS: Refractive surgery significantly improves military readiness and capabilities and vision-related quality of life of active duty U.S. military service members with refractive error. [J Refract Surg. 2018;34(9):597-603.].

Spectacles utilization and its impact on health-related quality of life among rural Chinese adolescents.

PURPOSE: The aims of the study were to assess the magnitude and predictors of the unmet need for spectacles utilization and to quantify its impact on health-related quality of life (HRQOL) among rural Chinese adolescents. METHODS: This school-based survey of 2346 grade-7 students (mean age: 13.8 years) was conducted in Southwestern China in 2016. Spectacles need was defined as uncorrected visual acuity (VA) of 20/40 or worse but correctable to 20/40 or better in the better-seeing eye, together with the presence of myopia of less than -0.5 diopters (D), hyperopia of more than +2.0 D, or astigmatism of more than 0.75 D in both eyes. The HRQOL was measured using self-reported versions of 23-item Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales (PedsQL 4.0). RESULTS: Among 579 (24.7%) adolescents with an uncorrected VA of 20/40 or less, 483 (83.4%) needed vision corrections and 172 (35.6%) used them. Higher parental education levels (odds ratio (OR) = 2.73; 95% CI, 1.29-5.77), negative attitude regarding spectacles (OR = 0.49; 95% CI, 0.25-0.97), and poorer uncorrected VA (OR = 31.27; 95% CI, 3.76-260.23) were independent determinants for spectacles utilization. Adolescents not using spectacles had a lower HRQOL score compared to those using spectacles in terms of psychosocial health (65.91 vs. 70.59; P = 0.028), emotional health (56.85 vs. 63.24; P = 0.012), and social functioning (72.99 vs. 78.60; P = 0.036). CONCLUSIONS: The rate of spectacles utilization in rural China was low. Adolescents were not accustomed to use spectacles had a worse HRQOL score.

Constructing Item Banks for Measuring Quality of Life in Refractive Error.

SIGNIFICANCE: Existing patient-reported outcome instruments in refractive error are paper-based questionnaires. They are not comprehensive and psychometrically robust. This study has identified the content of the refractive error-specific item banks that aim to provide comprehensive and scientific measurement of refractive error-specific quality of life. PURPOSE: The purpose of this study was to identify minimally representative, optimally informative, and efficient sets of items for measuring quality of life in people with refractive error. METHODS: First, items were identified from existing patient-reported outcome instruments. Second, items were developed from qualitative studies with people with refractive error (48 and 101 in-depth interviews in Australia and Nepal, respectively). Third, classification and selection of items were done based on a set of systematic criteria using an iterative process of binning and winnowing. The resulting items underwent cognitive testing with people with refractive error in Australia and in Nepal. Each step was guided by an expert panel consensus. RESULTS: We retrieved 792 items from the existing patient-reported outcome instruments. From the interviews conducted in Australia, a total of 2367 comments were coded into 807 initial items. Similarly, from the interviews conducted in Nepal, 3477 comments were coded into 914 initial items. After binning and winnowing, followed by cognitive testing, a final set of items comprising 337 items for the Item-pool (Australia) and 308 items for the Item-pool (Nepal), both spanning 12 domains, was obtained. Forty-seven percent of items were common across the two item pools. In the Item-pool (Nepal), 65% items were common for corrected and uncorrected refractive error. CONCLUSIONS: We identified the content of two different sets of item banks to comprehensively measure the impact of refractive error on quality of life for people in Australia and Nepal, which may be applicable to high-income country settings and low- and middle-income country settings, respectively. Future work aims to develop computer-adaptive testing system to administer the item banks, resulting in useful measurement tools for researchers, clinicians, and policy planners.

Relationship between Refraction, Anthropometrics, and Educational Status in a Nigerian Young Adult Population.

PURPOSE: The study aimed at determining the relationship between refraction and anthropometric measurements and the relationship between the level of education and refractive status in a Nigerian young adult population. MATERIALS AND METHODS: Healthy volunteers from the students and staff of a teaching hospital in South-Western Nigeria were studied. Demographic profiles including participants' highest educational status, parental educational level, and the age at first formal school enrollment were documented. The height and weight of the participants were measured. Noncycloplegic objective refraction was determined with autorefractor, and the spherical equivalent refraction (SER) of the right eye was used for analysis. SPSS 16 was used to explore the relationships between refraction, height, weight, and body mass index and the educational status of the participants. RESULTS: Two hundred and thirty-nine adults with a mean age of 28.4 ± 6.5 years comprising 116 males and 123 females were studied. The mean height, weight, body mass index, and right eye SER were 1.7 ± 0.1 m, 64.4 ± 12.2 kg, 23.6 ± 4.3 kg/m2, and -0.8 ± 1.4 D, respectively. Height was negatively correlated with the SER (R = -0.3, P < 0.01) in males but not in females. Refraction was not significantly related to weight or body mass index. Participants with higher levels of education were more likely to be myopic. Higher parental education and early formal school enrollment were significantly associated with myopia. CONCLUSION: This study demonstrated a significant positive relationship between height and myopia in male participants but not in females. Individual as well as parental higher levels of education have also shown a positive association with myopic tendency.

Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China: A Cluster Randomized Clinical Trial.

Importance: Visual impairment is common among children in rural China, but fewer than one-third of children with poor vision own and wear eyeglasses. Objective: To study the effect of hospital-based vision centers on academic performance, ownership of eyeglasses, and eyeglasses-wearing behavior in rural Chinese children. Design, Setting, and Participants: Cluster randomized, investigator-masked, clinical trial from September 2014 through June 2015. A vision center capable of providing refractive services was established in the Hospital of Yongshou County, a nationally designated poor county in rural Shaanxi Province, western China. All 31 rural primary schools in Yongshou County participated; participants were all children in grades 4 through 6 (aged approximately 10-12 years) with uncorrected visual acuity of Snellen 6/12 or worse in either eye (2613 children). Data analysis was conducted March through May 2016, and data were analyzed by the intention-to-treat principle. Interventions: After teacher-led vision screening early in the school year (September-October 2014), schools were randomly assigned to either early referral (December 2014-February 2015) to the vision center for refraction and free eyeglasses if needed or late referral (March-June 2015) for the identical intervention. Main Outcomes and Measures: The primary outcome was score on a study-administered mathematics test (June 2015) adjusted for baseline score. Secondary outcomes were self-reported eyeglasses ownership and wear at final examination (June 2015). Results: All 2613 children evaluated were of Han Chinese race/ethnicity, and 1209 (46.3%) were female. Twelve hundred children (45.9%) met the vision criteria. Among these, 543 (45.3%) were randomized to early screening and 657 (54.7%) to late screening; 433 (79.7%) of the early screening group and 516 (78.5%) of the late screening group completed the study. Of eligible children, 120 (27.7%) owned eyeglasses at baseline. The adjusted effect on test scores comparing early and late groups was 0.25 SD (95% CI, 0.01-0.48; 1-sided P = .04), with the point estimate equivalent to half a semester of additional learning. At the end of the study, 347 of the 433 participants in the early group (80%) reported owning eyeglasses and 326 (75%) reported wearing eyeglasses; among the 516 participants in the late group, 371 (61%) reported owning and 286 (55%) reported wearing eyeglasses. Conclusions and Relevance: In this study, early provision of free eyeglasses was seen to improve children's academic performance and wearing of spectacles. These findings suggest that a county hospital-based vision center may be an effective way to improve children's educational opportunities in rural China. Trial Registration: isrctn.org Identifier: ISRCTN03252665.

Reduced vision, refractive errors and health-related quality of life among adolescents in rural China.

BACKGROUND: To determine the associations of reduced presenting visual acuity (VA), refractive errors and health-related quality of life (HRQoL) in healthy adolescents in rural China. METHODS: A total of 2,235 grade 7 students without systemic medical problems from 10 middle schools aged 13-14 years in Mojiang, a small county located in southwestern China, were included in the analysis. Reduced VA was defined as presenting VA of worse than 6/12 in the presence of an ophthalmic aetiology which could be identified. The refractive status of each participant was measured after cycloplegia using an autorefractor. The Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales was used for measuring HRQoL of the participants. RESULTS: Among all the participants included in the data analysis, 279 (12.5 per cent) individuals were affected by reduced VA based on the better-seeing eye data. After adjusting for the effect of gender, body mass index, the education level of the father, and the use of a corrective device, the total (adjusted mean difference: -3.27; 95 per cent confidence interval [CI] -4.95 to -1.59; p = 0.01), social functioning (adjusted mean difference: -3.44; 95 per cent CI -5.87 to -1.01; p = 0.02) and school functioning scores (adjusted mean difference: -3.12; 95 per cent CI -5.89 to -0.35; p = 0.04) of the adolescents with reduced presenting VA were significantly lower compared with those with normal vision. The associations between corrected refractive errors and HRQoL were not significant. CONCLUSIONS: Healthy adolescents with reduced VA reported lower HRQoL scores including total, social functioning and school functioning scores, compared with those with normal vision.

Orthokeratology and Contact Lens Quality of Life Questionnaire (OCL-QoL).

OBJECTIVES: To develop a quality of life (QoL) instrument for patients fitted with Orthokeratology (OrthoK) and other modalities of contact lenses. METHODS: A 45-item pilot questionnaire was developed from an extensive literature review, focus groups, and interviews. Subsequently, 234 participants fitted with contact lenses (OrthoK, soft lenses, and gas permeable lenses) or spectacles completed the pilot questionnaire. Rasch analysis was used to assess the psychometric properties in terms of person separation, item fit statistics, category threshold ordering, differential item functioning (DIF), and targeting. A subset of participants completed the final questionnaire twice (1 week apart) and the repeatability assessed (within-subject standard deviation). The Spearman rank-order correlation coefficient between the questionnaire score and binocular visual acuity was calculated to assess construct validity. RESULTS: Inspection of category probability curves suggested that one category was underused and the response options were collapsed. Furthermore, Rasch analyses indicated 22 items misfitted the model and were removed. The final questionnaire contained 23 items with a person separation of 2.18, item fit statistics within the range 0.83 to 1.15, targeting 1.05 logits, and no significant DIF (<0.8 logits). The repeatability (Sr) was 4.21 and there was no correlation between questionnaire scores and binocular visual acuity (rs=0.03, P=0.65). CONCLUSIONS: The Orthokeratology and Contact Lens Quality of Life Questionnaire demonstrated excellent psychometric properties and is capable of measuring vision-related QoL in patients fitted with various forms of contact lenses including OrthoK lenses. The tool is scored on a 0 to 100 interval level scale with higher scores indicating better QoL.

Patient-reported Outcomes for Assessment of Quality of Life in Refractive Error: A Systematic Review.

SIGNIFICANCE: This review has identified the best existing patient-reported outcome (PRO) instruments in refractive error. The article highlights the limitations of the existing instruments and discusses the way forward. PURPOSE: A systematic review was conducted to identify the types of PROs used in refractive error, to determine the quality of the existing PRO instruments in terms of their psychometric properties, and to determine the limitations in the content of the existing PRO instruments. METHODS: Articles describing a PRO instrument measuring 1 or more domains of quality of life in people with refractive error were identified by electronic searches on the MEDLINE, PubMed, Scopus, Web of Science, and Cochrane databases. The information on content development, psychometric properties, validity, reliability, and responsiveness of those PRO instruments was extracted from the selected articles. The analysis was done based on a comprehensive set of assessment criteria. RESULTS: One hundred forty-eight articles describing 47 PRO instruments in refractive error were included in the review. Most of the articles (99 [66.9%]) used refractive error-specific PRO instruments. The PRO instruments comprised 19 refractive, 12 vision but nonrefractive, and 16 generic PRO instruments. Only 17 PRO instruments were validated in refractive error populations; six of them were developed using Rasch analysis. None of the PRO instruments has items across all domains of quality of life. The Quality of Life Impact of Refractive Correction, the Quality of Vision, and the Contact Lens Impact on Quality of Life have comparatively better quality with some limitations, compared with the other PRO instruments. CONCLUSIONS: This review describes the PRO instruments and informs the choice of an appropriate measure in refractive error. We identified need of a comprehensive and scientifically robust refractive error-specific PRO instrument. Item banking and computer-adaptive testing system can be the way to provide such an instrument.

Topical anaesthetic use prior to rigid gas permeable contact lens fitting.

PURPOSE: To investigate effect of topical anaesthetic (TA) during gas permeable (GP) contact lens (CL) fitting on subjective and objective measures of patient anxiety. METHODS: 47 subjects (mean±sd age=26.9±4.9years; soft CL wearers, 18, neophytes, 29). Each subject randomly assigned to Group A or B, and attended on two occasions, one week apart. First visit: subject received bilaterally either a single drop of TA (0.5% proxymetacaine) (Group A) or placebo (0.9% saline) (Group B) prior to GP CL application. No drops were instilled at second visit. Each visit mimicked a GP CL fitting. At each visit, patient anxiety was assessed either subjectively (visual analogue scale (VAS)) or objectively (skin conductance (SC)), as well as anterior ocular health. RESULTS: Visit 1: GP CL trial produced small increases in hyperaemia and corneal staining, but no difference associated with TA use. Visit 2: increases in staining and hyperaemia were observed, but hyperaemic responses significantly less than at Visit 1, for both groups. Corneal staining also less, but not statistically significant. VAS scores indicated subjects who received TA during Visit 1 were significantly less anxious at Visit 2. Visit 2: comfort slightly reduced for subjects who received TA at Visit 1, and significantly increased for subjects who received placebo. Use of TA reduced anxiety during lens adaptation period compared with subjects receiving placebo. CONCLUSIONS: TA use during GP CL fitting has potential patient benefits: improved first-time GP CL wear comfort, reduced anxiety during adaptation, reduced anxiety prior to subsequent GP CL wear.

Questionnaires for Measuring Refractive Surgery Outcomes.

PURPOSE: To identify the questionnaires used to assess refractive surgery outcomes, assess the available questionnaires in regard to their psychometric properties, validity, and reliability, and evaluate the performance of the available questionnaires in measuring refractive surgery outcomes. METHODS: An extensive literature search was done on PubMed, MEDLINE, Scopus, CINAHL, Cochrane, and Web of Science databases to identify articles that described or used at least one questionnaire to assess refractive surgery outcomes. The information on content quality, validity, reliability, responsiveness, and psychometric properties was extracted and analyzed based on an extensive set of quality criteria. RESULTS: Eighty-one articles describing 27 questionnaires (12 refractive error-specific, including 4 refractive surgery-specific, 7 vision-but-non-refractive, and 8 generic) were included in the review. Most articles (56, 69.1%) described refractive error-specific questionnaires. The Quality of Life Impact of Refractive Correction (QIRC), the Quality of Vision (QoV), and the Near Activity Visual Questionnaire (NAVQ) were originally constructed using Rasch analysis; others were developed using the Classical Test Theory. The National Eye Institute Refractive Quality of Life questionnaire was the most frequently used questionnaire, but it does not provide a valid measurement. The QoV, QIRC, and NAVQ are the three best existing questionnaires to assess visual symptoms, quality of life, and activity limitations, respectively. CONCLUSIONS: This review identified three superior quality questionnaires for measuring different aspects of quality of life in refractive surgery. Clinicians and researchers should choose a questionnaire based on the concept being measured with superior psychometric properties. [J Refract Surg. 2017;33(6):416-424.].

Impact of refractive error on quality of life: a qualitative study.

IMPORTANCE: This study qualitatively explores the impact of refractive error on adults, particularly after correction. BACKGROUND: The study aimed to explore the impact of refractive error on quality of life. DESIGN: Cross-sectional; in-depth telephone and face-to-face semistructured interviews; qualitative study with inductive and deductive processes. PARTICIPANTS: Forty-eight adults with refractive error (including presbyopia) were recruited from the Flinders Vision, the Ashford Advanced Eye Care and among Flinders University staff and students, in South Australia. METHODS: The interviews were audio-recorded, transcribed verbatim, coded and analysed using thematic analysis. MAIN OUTCOME MEASURES: Themes and categories RESULTS: The median age of the participants was 49 years (min: 22 years; max: 76 years). Most of them were female: (29; 59%). Most of them (36; 75.0%) had myopia followed by hyperopia (12; 25.0%). Twenty-two (45.8%) participants had astigmatism. Similarly, 23 (47.9%) of them were presbyopes. Most of the participants (39; 81.3%) wore glasses; 17 (35.4%) used contact lenses, and 17 (35.4%) had undergone refractive surgery. A total of 2367 comments were coded. Thematic analysis resulted into six themes that informed about quality of life issues in people with refractive error. Concerns about cosmetic appearance, personal health and safety, difficulties in day-to-day activities and inconveniences rendered in daily life were identified as the most important themes. CONCLUSIONS AND RELEVANCE: The findings of this study enrich the understanding on the issues important in people with refractive error. The quality of life issues identified will be used to develop a refractive error-specific item bank.

Comparison of Rating Scales in the Development of Patient-Reported Outcome Measures for Children with Eye Disorders.

BACKGROUND: A rating scale is a critical component of patient-reported outcome instrument design, but the optimal rating scale format for pediatric use has not been investigated. We compared rating scale performance when administering potential questionnaire items to children with eye disorders and their parents. METHODS: Three commonly used rating scales were evaluated: frequency (never, sometimes, often, always), severity (not at all, a little, some, a lot), and difficulty (not difficult, a little difficult, difficult, very difficult). Ten patient-derived items were formatted for each rating scale, and rating scale testing order was randomized. Both child and parent were asked to comment on any problems with, or a preference for, a particular scale. Any confusion about options or inability to answer was recorded. RESULTS: Twenty-one children, aged 5-17 years, with strabismus, amblyopia, or refractive error were recruited, each with one of their parents. Of the first 10 children, 4 (40%) had problems using the difficulty scale, compared with 1 (10%) using frequency, and none using severity. The difficulty scale was modified, replacing the word "difficult" with "hard." Eleven additional children (plus parents) then completed all 3 questionnaires. No children had problems using any scale. Four (36%) parents had problems using the difficulty ("hard") scale and 1 (9%) with frequency. Regarding preference, 6 (55%) of 11 children and 5 (50%) of 10 parents preferred using the frequency scale. CONCLUSIONS: Children and parents found the frequency scale and question format to be the most easily understood. Children and parents also expressed preference for the frequency scale, compared with the difficulty and severity scales. We recommend frequency rating scales for patient-reported outcome measures in pediatric populations.

Ocular Diseases Among Pathologists and Pathologists' Perceptions on Ocular Diseases: A Survey Study.

OBJECTIVE: The impact of visual disorders and color vision deficiency on the occupational life has been previously investigated by several studies. In this study, we aimed to evaluate the prevalence of visual disorders among Turkish pathologists and their perceptions on visual disorders. MATERIAL AND METHOD: A survey composed of 14 questions about ocular diseases and perceptions to these diseases has been introduced to the volunteering pathologists or pathology residents, participating in the 23rd Congress of Pathology. RESULTS: Ninety-three pathologists or pathology residents participated in the survey. Of the participants, 25 (26.9%) were residents, 30 (32.3%) were pathology specialists, and 36 (38.7%) were academicians. The mean duration for working as a pathologist was 15 years. The vast majority (%93.5) of the participants had at least one type of refractive error; the two most common disorders were myopia (77.0%) and astigmatism (64.4%). Sixty-four of the participants (68.8%) claimed an increase in their refractive error after working in the pathology department. Eyeglasses (56/87, 64.4%), contact lenses (14/87, 16.1%), or both (9/87, 10.3%) were used in order to correct the refractive error; however, only 31 of the participants (33.3%) preferred using eyeglasses during microscopy. While 65 participants (69.9%) never had conjunctivitis, 26 participants (28.0%) had at least one conjunctivitis attack. None of the participants claimed to be color blind. CONCLUSION: Conjunctivitis and refractive errors are quite prevalent among pathologists. Refractive errors were also found to increase during the pathology practice. Most of the pathologists do not consider visual disorders (mostly refractive errors) as a negative factor during their career decision making, except a color vision defect.

THE EFFECT OF LOW POWER GLASSES AT CLOSE DISTANCES ON VISUAL PERFORMANCE.

The purpose of this study was to reveal if the use of low power ophthalmic glasses (diopter values within the ± 1.00D range) in ophthalmic care may be beneficial for the treatment of low refractive vision disorders. 40 university students (10 men, 30 women), who used low power glasses at close distances (for reading on paper or on a computer screen: 40-60 centimeters approximately), voluntarily took part in this study. Ages of the participants ranged from 20 to 43 years (M = 24.9, SD = 4.4). Mean spherical refractive error was -0.38 diopters (SD = 0.49; range= -1.00-0.88). A yes/no Signal Detection procedure was used to assess whether the participants' visual sensitivity (d') or criterion of response (c) changed when they used the optical correction. There were no changes in visual sensitivity index, but significant changes in criterion of response were observed when the students used their optical correction. Changes in the criterion of response suggested the presence of a placebo effect.